A quarter of households in Algerian refugee camps suffer from both overweight and malnutrition, according to a new survey, calling into question the approach that government organisations have taken to dealing with the nutritional needs of the victims of protracted humanitarian crises.

The camps are located around the city of Tindouf, in the west of Algeria. The refugees were displaced from the disputed Western Sahara region (marked in red) in 1975 by Moroccan forces.

The study, published in PLoS Medicine, surveyed women and children from 2,005 refugee households from four camps in the Tindouf province of Algeria.

The study found 56.2% of the population were overweight and obese, and 50.5% of the population were malnourished; 24.7% of the households in the camps suffered from the symptoms of both, a concurrence which the authors of the study described as a “double burden”.

Only 18% of households housed residents with no effects of either overweight or malnutrition.

The researchers say that their study is the first investigating the prevalence and co-existence of undernutrition and overweight in a protracted refugee setting.

Study

In total, 1,758 children (aged between 6-59 months) and 2,748 women were surveyed for the study, and were measured for weight and height.

Overweight and obesity was rare in children, occurring in only 3.2% of the population surveyed, but undernutrition was common: acute malnutrition was found in 9.1% of cases, stunted growth was found in 29.1% of cases, and 18.6% of the children surveyed were underweight.

However, 31.8% of the women surveyed were overweight, and 21.9% were obese. Only 5.1% were underweight. 14.8% of women had stunted growth.

When measured by waist circumference, 71.4% of women had central obesity - a waist measuring over 80 centimetres.

Figure 1: The proportion of households classified as normal, "double burden", overweight, and undernourished in Western Sahara refugee camps, with overweight measured by BMI and waist circumference. Source: "The Double Burden of Obesity and Malnutrition in a Protracted Emergency Setting: A Cross-Sectional Study of Western Sahara Refugees".

The Tindouf camps

The refugees in the Tindouf camps are of the Sahrawi people, who were displaced from the disputed Western Sahara region in 1975-6. They and their descendents have lived in the camps since.

The exact population of the camps is unknown, but various estimates range from 40,000 to 160,000.

The study researchers name several possible factors causing the high levels of obesity in the population, due to aspects intrinsic to the Sahrawi population, as well as their refugee status.

The Sahrawi associate larger bodies with wealth and beauty, say the researchers, which has led to cultural practices involving periods of overfeeding and the use of traditional medication to attempt to induce fat accumulation.

It is also common for Sahrawi people to consume large amounts of sugar, including large amounts of heavily sugared green tea.

However, the Tindouf camps are located in hot desert areas with little to no vegetation, and the population is entirely dependent on international aid for food and water, meaning that their ordinary diet consists of low-diversity starchy foods, including cereals, pulses, and blended foods, with little, if any fruit or vegetables, a diet which has been associated with obesity and related comorbidities in one study.

The diet has also led to early-life under-nutrition, which is suspected to lead to overweight in later life.

The study authors say that their survey shows that food packages given out by international aid agencies, which are commonly designed around the needs of people facing acute humanitarian disasters, are poorly suited to the needs of refugees needing aid for protracted periods of time. They suggest further effort is needed to improve the diversity and nutritional effect of food packages.

“The Sahrawi refugees have been residing in camps since 1975,” say the authors. “Generations of adults from birth have received food assistance as their main source of food. Their children are now the second or third generation exposed to a consistently low-quality diet. The intergenerational impact of this exposure is of serious concern in this and similar protracted emergencies.”

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